    <div class="container">
      <div class="bg-putih">

        <div class="jdl-page">
          <?php echo isset($judul)?$judul:'<font color="#ccc">Judul Belum Diberikan</font>'; ?>
          <div class="clearfix"></div>
        </div>

        <?php echo form_open(uri_string(), array('class' => 'form-horizontal', 'role' => 'form', 'id' => 'form')); ?>
        <input type="hidden" name="KdKunjungan" value="<?php echo $data['KdKunjungan']; ?>">
        <div class="form-group">
          <label class="col-xs-2 control-label">Nama Pasien</label>
          <div class="col-xs-10">
          <script type="text/javascript">
            $(document).ready(function() {
              $("#pasien").select2();
            });
          </script>
          <select id="pasien" class="form-control input-sm" name="pasien">
            <?php  
            $klpk_getter      = $this->db->get('pasien');
            $res_klpk_getter  = $klpk_getter->result_array();
            foreach($res_klpk_getter as $klkpk_obat):
              ?>
            <?php 
            if($klkpk_obat['KdPasien'] == $data['KdPasien']): ?>
              <option value="<?php echo $klkpk_obat['KdPasien'] ?>" selected="selected"><?php echo $klkpk_obat['Nama'] ?></option>
            <?php else: ?>
              <option value="<?php echo $klkpk_obat['KdPasien'] ?>"><?php echo $klkpk_obat['Nama'] ?></option>
            <?php endif; ?>
            <?php
            endforeach;
            ?>
          </select>
          </div>
        </div>
        <div class="form-group">
          <label class="col-xs-2 control-label">TD</label>
          <div class="col-xs-10">
            <input type="text" name="td" value="<?php echo $data['TD']; ?>" class="form-control input-sm" placeholder="">
          </div>
        </div>
        <div class="form-group">
          <label class="col-xs-2 control-label">Suhu</label>
          <div class="col-xs-10">
            <input type="text" name="suhu" value="<?php echo $data['Suhu']; ?>" class="form-control input-sm" placeholder="">
          </div>
        </div>
        <div class="form-group">
          <label class="col-xs-2 control-label">RR</label>
          <div class="col-xs-10">
            <input type="text" name="rr" value="<?php echo $data['RR']; ?>" class="form-control input-sm" placeholder="">
          </div>
        </div>
        <div class="form-group">
          <label class="col-xs-2 control-label">HR</label>
          <div class="col-xs-10">
            <input type="text" name="hr" value="<?php echo $data['HR']; ?>" class="form-control input-sm" placeholder="">
          </div>
        </div>
        <div class="form-group">
          <label class="col-xs-2 control-label">Keluhan</label>
          <div class="col-xs-10">
            <textarea name="keluhan" id="keluhan" class="form-control input-sm" rows="3"><?php echo $data['Keluhan']; ?></textarea>
          </div>
        </div>
        <div class="form-group">
          <div class="col-xs-offset-2 col-xs-10">
            <button type="submit" class="btn btn-primary btn-sm">Perbaharui</button>
            <button type="reset" class="btn btn-default btn-sm">Kosongkan</button>
          </div>
        </div>
        <?php echo form_close(); ?>

        <div class="clearfix"></div>
      </div>
    </div> <!-- /container -->

    <script>
      /*$("#form").validate({
        rules: {
          nama: {
            required: true,
            minlength: 3
          },
          ket: {
            required: true         
          }
        }
      });*/
    </script>